Oral presentation of malignant mesothelioma

Our plain-English summary of Oral presentation of malignant mesothelioma, by L.J. Murray, J. Higham, S.K. Suvarna, et al (Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 2011).

The study

• Authors: L.J. Murray, J. Higham, S.K. Suvarna, G.T. Craig, C.H. Bridgewater, P.M. Fisher, M.H. Thornhill
• Journal: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
• Published: 2011;111(1):e21-6
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of metastatic mesothelioma presenting as an oral metastasis in a 46-year-old patient. The patient presented with 2 polypoid lesions that appeared to be benign on the dorsum of the tongue. Excisional biopsy showed the presence of metastatic carcinoma that on further investigation proved to be mesothelioma. The initial presentation of mesothelioma as an oral metastasis is not previously reported. This article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of the general dental practitioner in screening for oral neoplasms.

Copyright © 2011 Mosby, Inc. All rights reserved.

In plain English

This case report described a 46-year-old woman whose mesothelioma first appeared as lumps on her tongue. Her dentist noticed a swelling at a routine check-up; she had two lumps on the top of her tongue. Both looked harmless, but once removed they were found to contain cancer that had most likely spread from elsewhere. Scans showed nodular thickening of the lining around the left lung, and further staining led to a final diagnosis of mesothelioma. She recalled no asbestos exposure, but from about age 15 had worked about 8 years as a cleaner in old hospital and school buildings that may have contained asbestos. Chemotherapy, given with palliative (non-curative) intent, brought a good response, but about 6 months after it ended she developed a cancer deposit under the skin of her chest wall, then three tongue lumps that again proved to be mesothelioma. The authors found 5 earlier reports of mesothelioma spreading to the tongue, and said this presentation was not previously reported. The authors concluded the case highlighted the importance of biopsy for lumps presumed to be harmless.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a brief review of previously published cases
• Who was studied: one 46-year-old woman, otherwise fit and well, who went to her dentist for a routine dental examination
• Exposure: no asbestos exposure the patient could recall; from about age 15 she worked for about 8 years as a cleaner in old hospital and school buildings that may have contained asbestos (no fiber type or dose given)
• Main results:
  • Examination found 2 polypoid lesions on the top surface of the tongue.
  • The lesions looked like benign fibroepithelial polyps.
  • Initial examination of the removed tissue suggested cancer that had most likely spread from outside the head and neck.
  • CT scanning showed nodular thickening of the pleura throughout the left side of the chest.
  • After further staining, a final diagnosis of mesothelioma was made.
  • The patient received cisplatin and pemetrexed chemotherapy with palliative intent.
  • She had a good response to chemotherapy, but about 6 months after completing treatment developed a metastasis under the skin of her right posterior chest wall.
  • Three later tongue lesions were removed and again confirmed as mesothelioma.
  • The authors' review of English-language literature found 5 previously reported cases of mesothelioma spreading to the tongue.
  • The authors stated that this pattern of presentation (tongue metastases as the first sign) had not been reported before.
• The authors' conclusion: The authors concluded that the case highlights the importance of biopsy and microscopic diagnosis of lesions presumed to be benign.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Metastasis, Biopsy, Carcinoma, Neoplasm.

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